Variant 1: Adult. Acute thoracic back pain without myelopathy or radiculopathy. No red flags. No prior management. Initial imaging.
Variant 2: Adult. Subacute or chronic thoracic back pain without myelopathy or radiculopathy. No red flags. Failed conservative management. Initial imaging.
Variant 3: Adult. Thoracic back pain with myelopathy or radiculopathy. Initial imaging.
Variant 4: Adult. Thoracic back pain without or with myelopathy or radiculopathy. One or more of the following: low-velocity trauma, osteoporosis, elderly individual, or chronic steroid use. Initial imaging.
Variant 5: Adult. Thoracic back pain without or with myelopathy or radiculopathy. One or more of the following: suspicion of cancer, infection, or immunosuppression. Initial imaging.
Variant 6: Adult. Thoracic back pain without or with myelopathy or radiculopathy. Radiograph shows bone destruction or fracture or spinal deformity. Next imaging study.
Variant 7: Adult. Thoracic back pain without or with myelopathy or radiculopathy. Post thoracic spine surgery. Follow-up imaging.
Appendix Key

A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.

Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.

SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.

  • References: The citation number and PMID for the reference(s) associated with the recommendation.
  • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.

RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.

Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).

Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.